La médecine narrative face à l’impossible singularité des récits

Selon l’une des thèses les plus répétées de la médecine narrative, la théorie littéraire, ou plus largement, la narration, permettrait aux membres du personnel médical d’appréhender les récits des patients et par là, de prendre en considération leurs expériences dans leur singularité absolue. Dans ma contribution, je soulignerai quelques limites de cette thèse. J’appuierai mon analyse sur un exemple de récit dominant de maladie, les récits portant sur le cancer du sein aux États-Unis au XXe siècle, à partir des analyses féministes qui en ont été faites. Ainsi je montrerai d’une part qu’il est peu plausible que les récits des patients soient absolument singuliers et uniques, en un sens pertinent, et d’autre part que certains récits peuvent devenir dominants et marginaliser des récits qui voudraient s’en démarquer

La propaganda religiosa

The thesis concerns the study of religious propaganda in Italy. Starting from the definition of propaganda and the discipline of it in the past, the author deals with the limits of the phenomenon

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization’s Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the ‘Access’, ‘Watch’ and ‘Reserve’ classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the ‘Watch’ group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of ‘Watch’ group antibiotics increased from 2017 to 2021, with a drop in consumption of ‘Access’ antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.Fil: Nagassar, Rajeev P.. No especifíca;Fil: Jalim, Narin. No especifíca;Fil: Mitchell, Arianne. No especifíca;Fil: Harrinanan, Ashley. No especifíca;Fil: Mohammed, Anisa. No especifíca;Fil: Dookeeram, Darren K.. No especifíca;Fil: Marin, Danini. No especifíca;Fil: Giangreco, Lucia. No especifíca;Fil: Lichtenberger, Paola. No especifíca;Fil: Marin, Gustavo Horacio. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentin

Antimicrobial consumption at the hospital level in latin america. Similarities and differences according to each country

One of the main problems for health service around the world is the antimicrobial resistance (AMR). Objective: to describe the antimicrobial consumption (AMC) at hospital level in Latin American countries and compare the amount and type of antibiotics usage among them in order to guide local public health actions towards AMR prevention.Design: A descriptive study of antimicrobial consumption at hospital level among six health institution in Latin America with an analytical comparative stage. Antimicrobials included corresponded to the WHO Anatomical Therapeutic Chemical (ATC) classification system subgroups: J01, A07A and P01AB. Methods: WHO GLASS methodology was applied for surveillance of AMC, using the ATC classification based on Defined Daily Dose (DDD) and DDD/100 hospital discharges as standard unit of measurement. Antimicrobials consumed were also classified according to the WHO AccessWatch-Reserve (AWaRe) classification. Results: The quantitative data, measured in DDD/100 hospital discharges, showed a wide range of consumption (182.48 - 2260.95). Qualitative analysis according to the AWaRe classification also showed a wide range in terms of consumption of Access (38.14% - 73.64%), Watch (24.93% - 60 .53%) and Reserve (0.31% - 3.55%) groups expressed as a percentage of the total consumption.Conclusion: Great heterogeneity and arbitrariness exist in the selection of antimicrobials for hospital use. Although this situation might be explained on local antimicrobial resistance, the history of prescription, local pharmaceutical promotion, and pharmacological education of health professional in each country, particular habits and distinctive culture may justify the differential consumption patterns observed in each institution in this study.Fil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Giangreco, Luis. Universidad Nacional de La Plata; ArgentinaFil: Hernández, Yago. Universidad Nacional de La Plata; ArgentinaFil: Dorati, Cristian. Universidad Nacional de La Plata; ArgentinaFil: Mordujovich Buschiazzo, Perla. Universidad Nacional de La Plata; ArgentinaFil: Bay, María Rosa. Hospital Interzonal General de Agudos San Roque - Mb Gonnet ; Gobierno de la Provincia de Buenos Aires;Fil: Gonzalez, Gladys María Adriana. Hospital Interzonal General de Agudos San Roque - Mb Gonnet ; Gobierno de la Provincia de Buenos Aires;Fil: Aldunate, Francisca. Pontificia Universidad Católica de Chile; ChileFil: López Peña, Mónica. Ministerio de Salud y Protección Social; ColombiaFil: Martínez Parra, Adriana. Ministerio de Salud y Protección Social; ColombiaFil: Ching Fung, Shing Mi. Costa Rican social security; Costa RicaFil: Alfonso Arvez, María José. Ministry of Public Health and Social Welfare; ParaguayFil: Mantilla Ponte, Hilda. General Directorate of Medicines, Supplies and Drugs; PerúFil: Marin, Danini. General Directorate of Medicines, Supplies and Drugs; PerúFil: Rojas, Robin. General Directorate of Medicines, Supplies and Drugs; PerúFil: Castro, José Luis. Pan-American Health Organization; Estados Unido

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, coamoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using theWorld Health Organization’s Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the ‘Access’, ‘Watch’ and ‘Reserve’ classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the ‘Watch’ group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of ‘Watch’ group antibiotics increased from 2017 to 2021, with a drop in consumption of ‘Access’ antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.Facultad de Ciencias Médica

Manual del cultivo de café en el VRAEM

El Comité Especial de Articulación Intergubernamental (CEAI –VRAEM), pone a disposición de los productores, profesionales e interesados el “Manual del Cultivo de Café en el VRAEM”, con la finalidad de orientar y unificar los conocimientos y criterios técnicos para la correcta instalación, manejo y beneficio del cultivo de café, priorizando su difusión responsable en el campo para los agricultores, técnicos y especialistas. Este manual consta de cuatro capítulos: I. Establecimiento del cultivo. II. Manejo del Cultivo de Café. III. Cosecha y post cosecha del café. IV. Referencias bibliográficas

Indicadores de prescripción racional de medicamentos: factibilidad de aplicación en instituciones de las Américas

Objetivo. Evaluar la factibilidad de monitorear la calidad de la utilización de medicamentos en instituciones sanitarias de países de la Región de las Américas mediante indicadores de prescripción racional. Métodos. Se realizó un estudio cuantitativo de utilización de medicamentos durante el período 2016-2018. Se desarrollaron y seleccionaron indicadores de prescripción racional de acuerdo a referencias internacionales y a la mejor evidencia disponible para: 1) antiinflamatorios: porcentaje de prescripción de ibuprofeno y/o naproxeno sobre prescripción total de antinflamatorios no esteroideos; 2) antidiabéticos orales: metformina como porcentaje de todos los antidiabéticos prescritos, metformina y/o sulfonilureas como porcentaje de todos los antidiabéticos prescritos; 3) insulinas: insulina cristalina y NPH como porcentaje del total de insulinas prescritas y 4) medicamentos antihipertensivos: porcentaje de inhibidores de la enzima convertidora de la angiotensina (IECA), antagonistas de los receptores de la angiotensina II (ARA-II) y diuréticos tiazídicos sobre el total de antihipertensivos prescritos. Se empleó la dosis diaria definida (DDD) por 1 000 habitantes y día (DHD) como medida del consumo por institución. Resultados. La prescripción de metformina con relación a todos los antidiabéticos fue menor al valor del indicador de referencia (27,9%-67,6% vs. 88%), mientras que la prescripción de metformina y/o una sulfonilurea fue comparable con dicho valor (80,9%-97,5% vs. 88%). Los valores de insulina NPH, cristalina y NPH/ cristalina con relación a las insulinas prescritas fueron variables frente al valor del indicador de referencia (37,1%-100% vs. 75%). La prescripción de ibuprofeno y naproxeno estuvo por debajo del valor del indicador (20%-50% vs. 80%). El porcentaje de IECA, ARA-II y tiazidas respecto a todos los antihipertensivos osciló entre 65,2%-77,2% vs 65%, acorde al valor del indicador propuesto. Conclusiones. Se demostró la factibilidad de aplicar los indicadores de prescripción racional seleccionados y construidos, que proporcionan información útil para analizar la calidad de la prescripción en las instituciones sanitarias de países de la Región y representan una herramienta útil para su monitoreo periódico.Facultad de Ciencias Médica